1. Nutritional Management of Hepatic Encephalopathy Presented by Chris Theberge & Sara Murkowski

6. Alanine Transaminase (ALT) Aspartate Transaminase(AST) The Urea Cycle

12. Progression of Liver Diseases

13. Normal Liver

14. Alcoholic Fatty Liver

15. Cirrhotic Liver

16. Prognosis of Cirrhosis Child-Pugh and MELD Score Both used to determine prognosis of Cirrhosis (mortality and survival) Determine Need For Transplantation Used in studies to determine effect of treatment on liver function

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26. Stages of Hepatic Encephalophay Stage Symptoms I Mild Confusion, agitation, irritability, sleep disturbance, decreased attention II Lethargy, disorientation, inappropriate behavior, drowsiness III Somnolent but arousable, slurred speech, confused, aggressive IV Coma

30. Abnormal plasma amino acids: chronic liver disease Val 400 350 300 250 150 200 100 50 Thr Leu Ileu Lys Try Meth Phe Tau Asp Glu Ser Pro Gly Ala Tyr Orn His Arg Essential Non-Essential % of Normal Cerra, et al; JPEN, 1985 J. Y. Pang

50. * Significantly different from both lactoalbumin and maltodextrin. 1 Some individuals were removed based on more than 1 criterion. 2 Cases with HCC were censored at the time of HCC diagnosis. 3 The number of withdrawn patients who died or progressed to exclusion criteria within 12 mo from entry into the study is reported in parentheses. 4 Including the patient lost to follow-up. Study Profile of BCAA Trial BCAA Lactoalbumin Maltodextrin Total number 59 56 59 Lost to follow-up 1 — — Intention-to-treat analysis 58 56 59 Events (death, any cause, or progression of liver failure to exclusion criteria) 9 (15.5%) * 18 (32.1%) 16 (27.1%) Removed from systematic follow-up 1 7 4 4 Development of HCC 2 1 1 2 Noncompliance to treatment 3 5 (1) 2 (1) 0 Side effects 3 4 4 (1) 2 (1) 2 Treatment-unrelated diseases — 1 — Regular 3-mo follow-up 42 (71.2%) * 34 (60.7%) 39 (66.1%) Admission to hospital 15 (35.7%) * 27 (79.4%) 28 (71.8) Admission rate (patients/y) 0.6 ± 0.2 * 2.1 ± 0.5 1.9 ± 0.4 Total no. d in hospital 195 * 327 520

62. Significant

63. Not significant Combining survival data regardless of window of f/u showed no significant Difference in survival between BCAA and controls

67. TABLE 1 Randomized controlled trials of BCAA treatment in cirrhosis 1 1 bw, body weight; co, crossover study; pg, parallel group design. 2 Dietary BCAA not included. Data are in g/d except as noted. 3 Positive, BCAA significantly different; negative, BCAA not significantly different.

72. The Child-Turcotte-Pugh Classification